Employee's Certification

Employee's Certification

OMB: 3220-0140

IC ID: 33938

Information Collection (IC) Details

View Information Collection (IC)

Employee's Certification
 
No Modified
 
Required to Obtain or Retain Benefits
 
20 CFR 217(17)(f)(3) 20 CFR 219.30 - 219.35  (To search for a specific CFR, visit the Code of Federal Regulations.)

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form G-346 (03-18) Employee's Certification Form G-346 (03-18).pdf No   Paper Only
Form G-346sum (03-18) Employee's Certification Summary Form G-346sum All (03-18).pdf Yes No Printable Only
Form G-346sum (03-18) Employee's Certification Summary Form G-346sum Completed (03-18).pdf Yes No Printable Only

Income Security Survivor Compensation

RRB-22, Railroad Retirement, Survivor and Pensioner Benefit System   79 FR 58874

6,320 0
   
Individuals or Households
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 6,320 0 0 -580 0 6,900
Annual IC Time Burden (Hours) 527 0 0 -48 0 575
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
AA-7, Spouse/Divorced Spouse Application for Medicare Form AA-7 (01-12).pdf 05/30/2012
AA-3, Application for Spouse/Divorced Spouse Annuity Form AA-3 (07-17).pdf 10/03/2018
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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